Kids Winter Day Camp Registration

KIDS WINTER DAY CAMP REGISTRATION

2023 Kids Winter Day Camp Registration - Now open!

*Required

Payment

You should only be accessing this page after submitting online payment.

If you have not paid for your camp dates yet, please do not complete this form until after doing so. Pay for camp at our online store here. Payment must be received to confirm your place and complete registration.

2023 Kids Winter Day Camp Registration

Section 1: Camper Information

(Please complete a separate form for each camper you are registering)

Camper Last Name

Camper First Name

Date of Birth

Gender

Male

Female

Camper's Primary Street Address

City

State

Zip Code

Section 2: Parent/Guardian Information

(This person will serve as the primary contact; they are also the primary emergency contact & they are an authorized driver)

Parent/Guardian Last Name

Parent/Guardian First Name

Relation to Camper

Email for Confirmation

How did you hear about Beech Creek Adventure Camp?

Primary Phone

Secondary Phone

Different Residence than Camper?

Yes

If yes, complete address below

Parent/Guardian Street Address

City

State

Zip Code

Section 3: Additional Parents/Guardians & Emergency Contact Information

(Please provide at least one additional emergency contact in this section, different than the primary contact listed above)

Last Name

First Name

Relation to Camper

Authorized Driver?

Yes

Primary Phone

Secondary Phone

Emergency Contact?

Yes

Last Name

First Name

Relation to Camper

Authorized Driver?

Yes

Primary Phone

Secondary Phone

Emergency Contact?

Yes

Last Name

First Name

Relation to Camper

Authorized Driver?

Yes

Primary Phone

Secondary Phone

Emergency Contact?

Yes

Section 4: Camper Health & Medical Information

(Select all that apply)

If your child has an allergy, please specify the allergy here.

If your child has any existing conditions, please explain them here.

List any addtional specific medical, physical, emotional, or behavioral conditions that need to be considered.

List any medications your child will be bringing to camp.

Please explain any reasons your child's activity should be limited.

In the event that paramedics are called please list all medications currently taken by your child.

Medication Name

Dosage

How often?

Time Taken

Reason Taking

Medication Name

Dosage

How often?

Time Taken

Reason Taking

Medication Name

Dosage

How often?

Time Taken

Reason Taking

Medication Name

Dosage

How often?

Time Taken

Reason Taking

Section 5: Camp Dates Attending

(Select all that apply)

Please select only the camp dates that you paid for during online checkout.

If a camp date you had wanted to register for reached its limit during checkout, please indicate if you would like to be added to the waiting list by completing the wait list section.

January 16, 11am-3:30pm

February 20, 11am-3:30pm

Main Roster

January

February

Wait List

(Only complete this section to be added to the waiting list for full camp dates.

We will contact you if a space becomes available.)

January 16, 11am-3:30pm

February 20, 11am-3:30pm

Section 6: Waivers & Signature

Allergy Alert

Beech Creek Botanical Garden & Nature Preserve is a natural environment with potential allergens such as trees, plants, flowers, bees, etc. In addition, Beech Creek Botanical Garden & Nature Preserve is not a peanut-free environment. While we do our best not to offer nuts, we cannot protect against exposure to these allergens. If your child is susceptible to allergic reactions please be sure that you have taken all necessary precautions, including providing complete and thorough medical information and notifying our staff of your child’s allergies.

I have read and understand the Allergy Alert

General Release of Liability and Authorization for Treatment

This health information is correct to the best of my knowledge and the camper herein described has permission to engage in all camp activities, except as noted. In consideration for being allowed to participate in the Beech Creek Gardens programs, I agree to assume the risk of such activities and programs and further agree to hold harmless Beech Creek Gardens and its staff members conducting the activities from any and all claims, suits, losses, or related causes of action for damages including, but not limited to, such claims that may result from injury or death, accident or otherwise, during or arising in any way from the activities. I grant permission for my child to participate in all planned camp activities, understanding that competent leadership is provided. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp staff to secure and administer treatment, including hospitalization, for my child as named above. I acknowledge that this General Release of Liability and Authorization for Treatment is legally binding on me personally and on my heirs, personal representatives, successors, and assignees. Beech Creek Gardens is not responsible for lost, stolen, or damaged personal articles.

I have read and agree to the above terms & conditions

Photo Release

I authorize Beech Creek Gardens and its assignees to use any photograph, picture, or likeness of me or my child for promotional purposes.

I agree to the Photo Release

Cancellation Policy

Notice of cancellation must be received in writing at least 14 days prior to the scheduled camp date to receive a refund. You will be refunded the camp fee minus a $20 processing fee. No refunds will be issued with less than 14 business days notice. Beech Creek Gardens will only cancel a camp due to severe weather warnings and extremely high winds.

I have read and understand the cancellation policy

Parent/Guardian Signature

Use your mouse or finger to draw your signature in the box.

Date Submitted

Please review your answers for accuracy before submitting your form.

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2022 Winter Camp Form